Sinusitis

Sinusitis

What`s sinusitis?

• An acute inflammatory process involving one or more of the paranasal sinuses.
• A complication of 5%-10% of URIs in children.
• Persistence of URI symptoms >10 days without improvement.
• Maxillary and ethmoid sinuses are most frequently involved

Acute sinusitisCauses:1.Acute infective rhinitis.2.Swimming & diving .3.Dental extraction & infection.4.Fractures involving sinus.5.Barotrauma.


Predisposing factors:a.Local: Nasal obstruction. Sinus meatus obstruction. Neighboring infection. Previous infection.b.General: Debilitation & immune deficiency Mucociliary disorders (cystic fibrosis) Irritating atmospheric conditions.

Bacteriology:Usually mixed & preceded by viral infection * Strep. pneumonia, *Staph.aureus , *Moraxella catarrhalis * Kleb. ,E.coli .* Anaerobic infection ( dental origin).

pathophysiology

• With inflammation, the mucosal lining of the sinuses produce mucoid secretion. Bacteria invade and pus accumulates inside the sinus cavities.
• Postnasal drainage causes obstruction of nasal passages and an inflamed throat.
• If the sinus orifices are blocked by swollen mucosal lining, the pus cannot enter the nose and builds up pressure inside the sinus cavities

• Acute Sinusitis – respiratory symptoms last longer than 10 days but less than 30 days.
• Subacute sinusitis – respiratory symptoms persist longer than 30 days without improvement.
• Chronic sinusitis – respiratory symptoms last longer than 120 days.

Clinical presentation:1.Preceding URTI.2.Constitutional symptoms.(headache, fatigue, fever)3.Nasal obstruction.4.Nasal discharge ,postnasal drip & halitosis5.Sever facial pain over sinus , increases by bending or coughing.6.Swelling &tenderness over affected sinus.

Investigations:1.Endoscopical examinations.2.Radiological examinations. X-ray sinuses ,CT scan, MRI .



Differential diagnosis:1.Dental pain.2.Migraine.3.Trigeminal neuralgia.4.Neoplasms of sinuses.5.Infections eg. erysipelas & H.zoster.6.Temporal arteritis, Angioneurotic oedema & Insect bite.


treatment.:1. Tt. of infections.2. Tt. of pain.3. Decongestant4. Irrigation.

• Antimicrobials-treat for 10-14 days, depending upon severity, with one of the following:
• Amoxicillin:20-40mg/kg/d in 3 divided doses(>20kg, 250mg tid)
• Augmentin:25-45mg/kg/d in 2 divided doses(>20kg, 400mg q12) Use chewable or suspension if child is less than 40kg.
• Analgesia
• Acetaminophen , or ibuprofen
• Codeine – for severe pain
• Nasal douche with saline
• Rhinocort nasal spray – 2 sprays in each nostril every 12 hours for children over 6 years of age.

Non-pharmacological treatment

• Humidifier to relieve the drying of mucous membrane associated with mouth breathing
• Increase oral fluid intake
• Saline irrigation of the nostrils
• Moist heat over affected sinus
• Prolonged shower to help promote drainage

Chronic Sinusitis

Predisposing Factors:1. VMR ,AR.2. Smoking & other pollutions.3. Nasal polyposis.4. Endocrine disorder e.g. Myxedema.5. Cong.mucociliary disorders.


Bacteriology:Usually mixed*Strep. Including some anaerobic.*Pneumococci.*Proteus ,Pseudomonus &E.colli

Clinical features:Same as acute but lesser degree*Nasal &post nasal discharge of mucoid or purulent.*Headache; heavy or dull ache.*Anosmia or cacosmia.*Less sever constitutional symptoms.

Principles of Tt.:*Decongestants; - topical decongestants for a short time, - systemic may be of value.*Steroid may of benefit (systemic or local).*Systemic antibiotics.*Surgical drainage .

Complications of sinusitis:

the orbit is the most common complication of acute sinusitis in children

Mode of spread:1.Direct;through bony wall.2.Venous.3.Lymphatics.4.Via perineural space of Olfactory n.to subarachnoid space.

Types:1.Extracranial cx.s a.Osteomayelitis: Rare ,usually of frontal sinus, increases in young adults. Forehead oedema (Pott’s puffy tumor).b. orbital cx.s:Rare but more in children due to ethmoiditis










c.Others:1.Infection of nasopharynx.2.Lateral pharyngitis & Tonsillitis.3.Otitis media.4.Laryngotracheitis.5.Bronchitis.6.Association with bronchiectasis.7.Association with asthma.8.Polyarteritis,Tenosynovitis.

2.Intracranial cx.s:a. Meningitis +/- extradural or subdural abscesses.b. Cavernous sinus thrombosis.c. Brain lesion; according to affected sinus; 1.Frontal lobe abscess.(frontal). 2.Diffuse supp. Meningitis near cribriform plate(ethmoid). 3.Diffuse meningitis(sphenoid). 4.Max.sinusitis rarely causes ICCx.